Optimism About Heart Risk Pays Off

MONDAY, July 14 -- Men who thought they had a lower risk of dying from heart disease turned out to be right over the next 15 years, no matter what their conventional risk factors showed.

The death rate for men who had the optimistic point of view was only one-third that of those who listed themselves as being at average risk, said the report in the July/August issue of the Annals of Family Medicine.

But the happy result of an upbeat outlook was not seen among the women in the study. The cardiovascular death rate was the same for women who listed themselves as having below-average risk as for those who said they were at average risk.

The lesson of the study isn't that men can cheerfully ignore what their doctors tell them about risk factors such as cholesterol, smoking and obesity, said Dr. Robert Gramling, who led the study while at Brown University. He now is assistant professor of family medicine at the University of Rochester, in New York.

It does say that physicians could do a better job of describing risk factors and what to do about them, Gramling said.

"In medical systems, we often have a pessimistic bias," he said. "We use normative language, telling people their risk might be high. Using the Framingham Heart Score places a fair amount of people into the categories of high or very high risk. After the age of 40, 80 percent might be viewed as at high risk."

That is how a physician would see it, but it is a question "of how we communicate uncertainty to patients about different aspects of medical care," he said.

A high-risk classification often strikes fear, "and I would suggest that fear-based prevention, meaning making changes based on fear, is not as helpful as holding an optimistic view," Gramling said. "We should focus on helping make changes easy to do, rather than on making people more fearful."

The failure to see a similar effect in women can be explained by the era in which the study was started -- the early 1990s, when the focus was entirely on the risk of cardiovascular disease for men, he said.

Today, it is widely known that cardiovascular disease is the leading cause of death for American women as well as men, Gramling said. "So, in men, you got more of a fear response," he said. "In women, being at higher risk was not as threatening. That might not be true any more."

Gramling is working along the same lines at Rochester. "The next step is to test under what conditions holding an optimistic view is most helpful and under what conditions it is not helpful," he said.

Meanwhile, there is no harm in feeling cheerful about cardiovascular health, as long as you follow the advice about the value of a good diet, exercise, blood pressure control and the like, Gramling said.

Another report in the same issue of the journal described a helpful outcome of combined treatment for high blood pressure and depression. A study of 64 adults found that those who had drug therapy for both conditions simultaneously achieved lower blood pressure level and were more likely to take their antidepressant drugs on schedule, according to physicians at the University of Pennsylvania.